When King Louis XVI, his two brothers and his sister-in-law were inoculated against smallpox in 18th-century France, the public worried about the risks. Though the experiment was a success, even sparking a new type of hairstyle, the doubts never went away. As vaccines took off during the 19th century, the age of Pasteur, so did resistance, apathy and distrust.

A similar challenge faces French President Emmanuel Macron, who’s holed up in the Elysee Palace after testing positive for COVID-19, triggering knock-on quarantines for several European leaders. He’s scrambling to prepare his country, exhausted by repeated lockdowns, for vaccines against SARS-CoV-2. Getting it right in France, where vaccine hesitancy is high and faith in institutions bruised, will be a critical test case for Europe.

Much has been made of the European Union’s sluggishness in giving the green light for the first vaccine, lagging the UK and the US. After some arm-twisting from Germany, where the coronavirus’s second wave is taking a harsh toll, the bloc’s top drug supervisor looks set to approve the Pfizer-BioNTech vaccine on Dec. 21, a week earlier than planned. As a result, the first shots are now slated to be given on the continent before the year is out.

But it’s only the beginning of the logistical complexity. While the EU has pre-ordered some 2 billion doses for its 450 million citizens, they won’t all arrive at once and they haven’t all been approved. French orders of the Pfizer vaccine run to about 45 million, which means around 22 million people can receive the two-shot course. That would cover all of France’s over-65s, but it’s only one-third of the population. Every dose will count, something made harder by the complex supply chain of this vaccine, requiring storage at minus 70 degrees Celsius, meaning a higher risk of doses accidently going to waste.

What will really count here -- as with other aspects of the COVID-19 fight -- is having an efficient and effective public sector. But that hasn’t been entirely straightforward for Europe, even dirigiste France. The first wave in the spring exposed a lack of medical equipment such as face-masks; the second in the fall an inability to build an effective test-and-trace system. Years of centralization and budget cuts have eroded public services.

Many countries, even Germany, have been humbled by the virus, but Macron’s advisers know there’s no room for error in the eyes of voters. That will mean enlisting support from tired medical personnel: Doctors will be the trusted first port of call, but also nurses and care workers, and later pharmacies, of which there are more than 21,000 in France.

France’s biggest challenge, however, is convincing people to actually take the vaccine once it arrives. A recent Ipsos survey found that only 54 percent of French adults would be willing to get a COVID shot when it’s available, the lowest score of 15 countries. (The US was second-to-last.) Another found only 19 percent of nursing-home workers are willing to get the shot. There are many factors at work, from frustration with a highly medicalized society that over-consumes antibiotics to doctors’ own regrettable ambivalence over mandatory vaccines. We don’t know how these surveys will translate to reality. But pro-vaccination campaigns need to be launched fast.

That’s what makes the timing, and potentially the circumstances, of Macron’s COVID infection so unfortunate. With luck it won’t lead to any serious health effects, but it has already prompted debate over whether the president followed the rules strictly enough. On Wednesday, Macron dined with 11 political allies and figureheads, more than the government’s recommended maximum of six.

The kerfuffle is providing fodder to his rivals on the far left and far right, who are grabbing airtime to cynically sow doubts over the efficacy of vaccines such as Pfizer’s, despite the evidence. It comes just as Macron’s approval ratings had begun to rebound, helped by a second lockdown that was less draconian than the first, yet which brought France’s daily death rate to below 6 per million from almost 10.

In the larger scheme of things, today’s haggling over one or two weeks’ delay in approving vaccines may look quaint next year. Goldman Sachs estimates the UK will vaccinate half its population by March, while the EU, Japan and Australia will reach this level of immunization by May.

But the stakes couldn’t be higher. Vaccines are critical for a return to some semblance of normality, and an economic recovery to go with it. France, and Europe, have big hurdles to clear.


Lionel Laurent
Lionel Laurent is a Bloomberg Opinion columnist covering the European Union and France. -- Ed.

(Bloomberg)